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发表于 2003-10-30 13:07
[B]Are Booster Shots for Hepatitis B Necessary?[/B]
from Medscape Pediatrics
Question
Are booster shots for hepatitis B necessary, and if so, how often should they be given? F. Noorani, MD
Response
from William Cassidy, MD, 03/01/2001
Neither the Advisory Committee for Immunization Practices (ACIP) in the United States nor the European Consensus Group on Hepatitis B Immunity recommends booster doses for most children and adults.[1,2] A postvaccination anti-HBs titer of greater than or equal to 10 mIU/mL is associated with protection against clinically significant HBV infection and is widely accepted as a protective response to vaccination.[3] Concern often arises when HBsAb titers are later found to have waned to less than 10 mIU/mL (ie, below protective levels).
Unlike HBiG, the HBV vaccine induces immunologic memory. In vitro studies show that if the vaccine series initially induces an HBsAb titer of greater than or equal to 10 mIU/mL, then memory B and T cells retain the capacity to generate antibodies upon re-exposure to B surface antigen even if the HBsAb titer falls to less than 10 mIU/mL.[4,5] Clinical trials in infants, adolescents, and adults have shown that, in those successfully immunized, antibody titers remain high and few become carriers in follow-up periods as long as 12 years.[6-9]
Subclinical breakthrough HBV infections have been reported in persons previously vaccinated who live in endemic areas or who live with family members who are chronic carriers.[9,10] In a prospective study, breakthrough infections were detected through HBcAb seroconversion in 1630 vaccinated patients. A total of 13 cases, or 0.8%, were identified over a 10-year follow-up period; none had clinically significant infections.[9] It appears, therefore, that even in those in whom immunologic memory does not completely prevent infection, the infections that do occur are subclinical and do not result in morbidity or mortality.
There is one situation where annual monitoring of HBsAb titers is recommended: renal failure patients and other immunocompromised hosts who are at high risk for HBV exposure.[1,2] If the titer is less than 10 mIU/mL, a booster dose should be given. T helper cell function is compromised in these hosts and therefore immunologic memory is not reliable.
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References
Centers for Disease Control and Prevention. Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of vaccines and immune globulins in persons with altered immunocompetence. MMWR Morb Mortal Wkly Rep. 1993;42(No. RR-4).1-18. Available at
http://www.cdc.gov/mmwr/preview/ mmwrhtml/00023141.htm
European Consensus Group on Hepatitis B Immunity. Are booster immunisations needed for lifelong hepatitis B immunity? European Consensus Group on Hepatitis B Immunity. Lancet. 2000;355:561-565.
World Health Organization. Thirteenth meeting of Global Advisory Group of EPI. Wkly Epidemiol Rec. 1992;1/2:3-7 and 3:9-12.
Van Hattum J, Maikoe T, Poel J, et al. In vitro anti-HBs production by individual B cells of responders to hepatitis B vaccination who lost anti-HBs. In: Hollinger FJ et al, eds. Viral Hepatitis and Liver Disease. Baltimore: Williams & Wilkins; 1992:774-776.
Leroux-Roels G, Van Hecke E, Michielsen, et al. Correlation between in vivo humoral and in vitro cellular immune responses following immunization with hepatitis B surface antigen (HBsAg) vaccines. Vaccine. 1994;12:812-818.
West DJ, Watson B, Lichtman J, et al. Persistence of immunologic memory for twelve years in children given hepatitis B vaccine in infancy. Pediatr Infect Dis J.1994;13:745-747.
Wu JS, Hwang L-Y, Goodman KJ, Beasley RP. Hepatitis B vaccination in high-risk infants: 10-year follow-up. J Infect Dis. 1999;179:1319-1325.
Cassidy WM, Watson B , Ioli V, et al. A randomized trial of alternative 2 and 3-dose hepatitis B vaccination regimens in adolescents: antibody responses, safety, and immunologic memory. Pediatrics. In press.
Wainwright RB, Bulkow LR, Parkinson AJ, et al. Protection provided by hepatitis B vaccine in a Yupik Eskimo population: results of a 10 year study. J Infect Dis. 1997;175:674-677.
Shih HH, Chang MH, Hsu HY, Lee PI, Ni YH, Chen DS. Long term immune response of universal hepatitis B vaccination in infancy: a community-based study in Taiwan. Pediatr Infect Dis J. 1999;18:427-432.
About the Panel Members
Associate Professor of Medicine, Department of Internal Medicine, Earl K. Long Medical Center, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana.
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